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Diet and the Risk of Heart Disease Coronary heart disease -- CHD -- is our nation's number one killer. Fortunately, we know a great deal about the factors that put people at risk for CHD, and which of those factors are in our power to change. Much of the research into risk factors for CHD indicates that changes in diet and lifestyle can help reduce some people's risk for CHD -- even people who are genetically pre-disposed to developing it. By looking at all the risk factors that apply to you, identifying the ones in your control, and working to make positive changes, you stand an excellent chance of reducing your risk of CHD. The Cholesterol Connection If you want to know about your risk of heart disease, the first thing you need to do is get a blood test to check your cholesterol level. The test will measure the amount of cholesterol in your blood, which is an extremely important indicator of your risk for heart disease. While it is normal to have some cholesterol in your blood, it can be dangerous to have too much. This can happen if you eat a diet that is too high in cholesterol or in the saturated fats that can increase your cholesterol level. How high is too high? How low should you go? The answers are pretty clear-cut. Cholesterol Levels High

240 or more

Borderline-high

200-239

Desirable

Below 200

A high cholesterol level is a huge risk factor for CHD. According to the results of the famous Framingham study, which tracked cholesterol levels of 5,000 men and women over 20 years, men with average blood cholesterol levels of 260 had three times more heart attacks than men with average blood cholesterol levels of 195. If your cholesterol level is high, here are some ways to lower it. l l l l l

Reduce your saturated fat intake to less than 10 percent of the total fat in your diet. Reduce the amount of dietary cholesterol you eat. Reduce your fat intake to less than 30 percent of your total diet. Eat more soluble fiber. Maintain your ideal weight.

HDL (Good) Cholesterol and LDL (Bad) Cholesterol Your total cholesterol level includes two different types of cholesterol in your blood: HDL and LDL cholesterol. HDL and LDL are both lipoproteins, or protein-containing packages in which cholesterol travels through the bloodstream. The acronyms stand for High Density Lipoprotein and Low Density Lipoprotein. HDL cholesterol is considered beneficial, but LDL cholesterol is considered undesirable; read on to find out why. HDL Cholesterol l l l l

Think of this as the cholesterol that is taken out of your arteries, or the detergent that sweeps cholesterol away. Your HDL level is a key factor in your risk of heart attack. For example, if your HDL level is low (below 35), you are at risk even if your total cholesterol is only 200. But if your HDL level is up around 80, your risk is lower -- even through your total cholesterol may be as high as 250. A good general rule is, the higher your HDL cholesterol, the better. Women's HDL levels tend to be above 45, a good protective start against heart disease.

HDL Levels Low

Below 35

Intermediate

35-39

High

60 or more

It is not exactly clear how to raise your HDL, but high HDL has been associated to some extent with the following factors. l l l l l

plenty of exercise modest alcohol intake low fat consumption low saturated fat consumption low consumption of trans fatty acids

LDL Cholesterol l l l l l

This is the cholesterol that clogs your arteries. The lower your level of LDL cholesterol, the better for your heart health. In the US, more than half of men over 35 and women over 45 have high levels of LDL. LDLs can be small or large; small LDLs have been linked to undesirably low levels of HDL (good) cholesterol and to high levels of triglycerides. One of three men and one of six post-menopausal women have more small LDLs than large ones and may therefore be at higher risk for CHD.

LDL Levels High

160 or above

Borderline

Below 130

A Vegetable is defined as a non-woody plant cultivated for the table and of which the roots, tubers, stems, leaves and fruits are consumed. Unlike cereals and pulses vegetables need more amount of labour to grow and transport them; for they require constant attention and frequent watering, and tend to perish on the way to the cities if transport facilities are poor. CLASSIFICATION In the context of nutrition, vegetables can be divided into the following groups: n

Green and leafy vegetables: Cabbage, cauliflower, coriander, lettuce, spinach.

n

Other vegetables: Brinjal, cucumber, drumstick, bitter gourd(karela), parwar, white pumpkin, tindola, tomato.

n

Roots and tubers: Potato, sweet potato, onion, beetroot, carrot, radish, yam.

n

Legumes: Double beans, french beans, green peas, cluster beans(guar phali).

Green and leafy vegetables and Other vegetables: These vegetables contain a high proportion of cellulose which human intestinal juices (unlike those of herbivorous animals) cannot digest. It thus remains unabsorbed and increases the bulk of the intestinal contents These vegetables are helpful in weight reduction diets as they give a feeling of satiety but provide few calories. They bulk and water content also helps in the treatment of constipation. They are rich source of carotene, vitamin C and potassium. Vitamin C content of some green and leafy vegetables, and other vegetables Vegetables Bitter gourd Cabbage Cauliflower Coriander Drumstick Drumstick leaves Tomato

Vitamin C per 100 g(mg) 96 124 66 135 120 220 31

Roots and tubers: The root of a plant serves two functions: l

It acts as an anchor

l

It absorbs water and minerals

A tuber is a storage organ, and is a short thickened portion of an underground stem, a common example being the potato. More calories can be derived from an acre of potatoes than from growing most other crops. Potatoes and sweet potatoes are rich in starch. Potatoes contain 75% water, 20% starch and only 2% protein; It is rich in amino acid lysine. The vitamin C content of freshly dug main-crop potato is high (30mg per 100 gms) but it is reduced to 8 mg after storage for 9 months. Cooking unpeeled potatoes conserves most of the vitamin B and C, and salts in the skin. Peeling a potato and cutting it into pieces before it is boiled reduces its vitamin content considerably. If cooked potatoes are reheated, there is a further loss of vitamins. Carrots are rich in carotene; the red variety contains 10 - 15 times more carotene than the yellow variety. Onions are widely used in tropical countries. The white variety contains more water than the brown or the red variety and can't be stored well. Onions have a pungent taste, and as water evaporates during storage, the pungency is increased. The principal chemical constituent in onion, which gives it it's taste and pungent odour and brings tears to the eyes, is the sulphur containing volatile oil, allyl ropyl bisulphide. If uncooked onion is consumed the volatile oil is excreted through the lungs and saliva giving a characteristic odour to the breath. Vitamin C content is higher in green onions, especially in their central parts than in the stored ones. Raw, fresh onion can be a cheap source of vitamin C, paricularly for poor villagers. Legumes Dried legumes like gram, peas and beans are grouped as pulses. Green legumes like green peas, french beans, and cluster beans are used as vegetables. Green peas contain about 7% proteins, and supply about 100 kcal per 100 gms. Cluster Beans Guar gum made from cluster beans is frequently used as a thickening agent as well as for providing dietary fibre. A dietary supplement of guar gum crisp bread decreases fasting blood sugar.

Brain Foods-- Foods to keep your memory intact: Blueberries, Strawberries and Spinach act as brainboosters What makes these foods so potent? l l

l

l

l

The above have been shown to protect brain cells from the onslaughts of ageing Blueberries (Jamun as commonly known in India) and strawberries are rich in anthocyanins, formidable antioxidants in deep red and purple pigments. Studies suggest anthocyanins may protect the neurons ability to respond to chemical messengers; they also seem to discourage blood clots from forming. Spinach is a antioxidant powerhouse, bursting with betacarotene, vitamin C and folic acid. All three foods contain other compounds that keep blood vessels supple and help transport nerve impulses more efficiently. These substances almost certainly get their oomps from teamwork, which is why researchers advise eating the foods rather than popping a supplement made from them

Diet in Childhood The rapid growth which occurs in foetal life

and during infancy is followed by a long period of gradual growth during childhood. This is the time when the child starts exploring his environment and gets exposed to the school situation. The number of influences on his mind are, therefore, increased and his world of interaction widened. This affects his food behaviour and eating patterns, some of which may be considered problem issues. With careful understanding, these problems may only be transient and can be overcome easily. However due to poor eating habits, children particularly preschoolers, are more easily prone to deficiencies like protein energy malnutrition, anaemia and vitamin A deficiency. Although by school age, children have established a particularl pattern of meal intake, they continue to be affected by the influences of their peers and the mass media. At the same time they are burdened by the heavy schoolwork, class competition and proneness to communicable diseases. The influences of childhood get further pronounced during adolescence. A proper well balanced diet, good eating habits, a good school lunch program combined with some amount of nutrition awareness goes a long way in improving their nutritional status.

Recommended Energy Allowances for Children Group

Age (years)

Energy (kcal/day)

Children

1 to 3

1240

4 to 6

1690

7to 9

1950

Boys

10 to 12

2190

Girls

10 to 12

1970

Recommended Allowances of Proteins for Children Group

Age (years)

Energy (g/d)

Children

1 to 3

22

4 to 6

30

7to 9

41

Boys

10 to 12

54

Girls

10 to 12

57

Diet and Feeding Pattern The preschool years are ones that create a number of concerns about food intake. The disinterest in certain foods may last from a few months to a few years. Food preferences may change from time to time, that may range from day to day or week to week. All the same, certain foods are accepted only when cooked or served in a particular way. Appetite is erratic, with the result the child may often eat one meal well but refuses the next. In spite of this preschoolers enjoy well prepared and attractively served food. They prefer simple unmixed dishes which are neither too hot nor too cold. Familiar foods are better liked and, hence, small portions of new foods should be introduced only with already well accepted foods. A balance should be maintained between hard and soft foods, and strong and mildly flavoured foods in the meals. Colourful foods add variety and stimulate interest. Foods should be such that can be easily manipulated and handled as preschoolers are generally clumsy. Handy finger foods like cutlets, hard boiled eggs, small sandwiches, rolls and whole fruits are easy to pick and eat, especially at school. Even at the table small pieces of food that can be easily handled with the spoon or fork should be served. Physical comfort in sitting, deep unbreakable bowls, and cutlery with blunt edges helps the child in his efforts in self feeding. Vegetables are generally disliked and consumption of sweets may be excessive. These however should not be treated as issues by parents and handled with care. Too much of attention at meal times only makes the child resort to unfair means of achieving their ends.

A Days Sample Diet Plan for a Five Year old Child

Namrita is a five year old daughter of a government Officer. She attends Nursery school from 0900 hrs to 1200 hrs. She takes a packed mid morning tiffin to school which she likes to eat while playing around. Her entire family is vegetarian in their food habits. A day's diet for her is planned below:

Personal Data Age

5 years

Sex

Female

Socio-economic Status

MIG

Food Habits

Vegetarian

Recommended Dietary Allowances Energy

1690 kcals

Protein

30 g

Vitamin A Iron

400 µg retinol 18 mg

Sample Menu Plan Meal

Menu

Early Morning

Milk

Breakfast

Cheese Toast

Mid-Morning (packed tiffin)

Rava idli Pear

Lunch

Channa Curry Boiled Rice Carrot & Cucumber salad Mint Raita

Evening Tea

Banana Shake Bread Roll with Sprouts filling

Dinner

Potato Paneer Curry Dry Tindas Chapattis Cabbage Kheer

Diet in Adulthood Our body requires different nutrients in varying proportions so as to maintain proper body functions. By the time one reaches adulthood, body growth, particularly in terms of height and body stature, stops to a certain extent. Despite the fact that there is not much of apparent growth, the breakdown and repair of body tissues goes on continuously even among adults. Therefore, adequate amounts of all the essential nutrients need to be provided to adults through their diets for maintaining both physical and mental health. Proper nutrition in adulthood ensures good health right until old age. Various factors which affect our body needs for different nutrients include age, sex activity and the body weight, height and composition, ie, the body physique. Apart from these, climatic conditions, body growth, physiological and pathological stress also influence the body's need for various nutrients Do You Know? • Oils containing adequate amounts of mono-saturated and poly-unsaturated fatty acids MUFA and PUFA such as coconut oil, sunflower oil, soyabean oil, etc., should be included in the diets of adults so as to reduce the risk of hypertension, atherosclerosis and other cardiovascular disorders during middle age and old age. • Adequate intake of calcium needs to be ensured during this age group to reduce the extent of osteoporosis which is normal phenomenon associated with ageing • Women have higher iron requirements, so more of iron rich foods like whole cereals, pulses with husk, green leafy vegetables like amaranth, mustard leaves, bengal gram leaves, mint as well as the haeme iron sources such as liver kidney, egg yolk and mutton muscles etc. need to be provided in their diets. • Care should be taken to include adequate amounts of raw fruits and vegetables so as to provide sufficient dietary fibre.

A DAYS SAMPLE DIET FOR AN ADULT MAN

Mr D S Sachan , aged 30, is employed as an office superintendent. Besides his occupational activities from 0930 hrs to 1730 hrs, he is engaged in household activities and goes for early morning jogging regularly. He is an ovo-vegetarian by choice. A days sample diet for him has been planned here. PERSONAL DATA Age

30 years

Sex

Male

Physical Activity Socio-Economic status

Moderate MIG (Middle Income Group)

Food Habits

Ovo-vegetarian RECOMMENDED DIETARY ALLOWANCES

Energy

2875 kcal.

Protein

60 g

Calcium

0.4 g

Thiamine

1.4 mg MENU PLAN

Meal

Menu

Early Morning

Tea

Breakfast

Broken wheat porridge French toast coffee Papaya

Lunch (packed)

Urad dal (dry) Palak paneer Paranthas Apple and carrot salad

Evening tea

Tea Vegetable and rice flakes Cutlets

Dinner

Rajmah curry Stuffed Tinda Zeera Pulao Chappatis Salad Sago Kheer

Arthritis and Diet control Forty million Americans have some form of arthritis today -- and the number is growing fast. As our population ages, the number of Americans affected will increase to 60 million by the year 2020. That is one in every five people. Can a nutritional approach help those who suffer chronically from the pain, swelling and joint stiffness of arthritis? There is some evidence that it can. Fatty Acids Omega-3 fatty acids, primarily found in oily fish, may reduce the symptoms of rheumatoid arthritis. They appear to suppress the immune system response that causes joint inflammation. In studies involving large doses of fish oil supplements (2.4 to 5 grams a day), there was some evidence of reduced stiffness and pain; the results were relatively meager -- but promising. Fish that are rich in Omega-3 fatty acids include: l l l l l l

salmon mackerel herring sardines tuna anchovies

Check with your doctor before taking large doses of fish oil, since it can also affect blood clotting, and it may interact with medications you are taking. The Omega-6 fatty acid GLA, or gamma-linolenic acid, may suppress the production of prostaglandins that trigger inflammation. Two studies have shown promising results from using one to three grams a day. Finding a good source of GLA is more problematic. Evening primrose oil contains some, but it is quite expensive. Unfortunately, other herbal preparations may be weak or inconsistent in their dose. Vitamins The anti-oxidant effect of vitamins C, D, E and beta-carotene may offer protection from certain types of arthritis, in the following ways. l

l l

Vitamins C and D may help with osteoarthritis. One promising study showed a slowing in the progression of osteoarthritis of the knee at doses of less than 150 milligrams of vitamin C (the equivalent of two 8-ounce glasses of orange juice) and 400 IU of vitamin D. Vitamin E has been shown to reduce pain and inflammation. Low beta-carotene levels have been linked to rheumatoid arthritis.

Getting adequate amounts of these nutrients is easy; a diet rich in fruits and vegetables should provide you with quite enough. Diet Regimens A vegetarian diet has been shown to be effective in reducing the symptoms of rheumatoid arthritis in at least one study. The diet regimen in this study consisted of: l l l l

no animal meat more fruits and vegetables less fat more Omega-3 fatty acids

However, it is not clear which component or combination of them was responsible for the positive results. If you decide to try a vegetarian diet, it is very important to make sure you are getting enough protein. Another common diet remedy, avoiding the "nightshade" vegetables, has not been proven reliable in research studies. Some accounts suggest that arthritis could be triggered by certain foods, the same way food allergies are triggered. If you suspect that a particular food is somehow associated with your arthritis flaring up, try eliminating it for a couple of weeks and then reintroducing it back into your diet to see what happens. To avoid the risk of adverse nutritional consequences, do not try to eliminate entire groups of foods at one time. Latest Cure? Jason Theodoskis' controversial best seller, The Arthritis Cure, recommends using the dietary supplements glucosamine and chondoitin to treat arthritis. (These compounds supposedly stimulate the growth of cartilage.) While both substances are safe to use and have been shown to provide pain relief, the skeptics would hardly call them a "cure." In addition, because they are supplements, they are not regulated, so the actual dose and purity of the various forms that are available may vary. Buyer beware. What else can you do? l l

l

Control Your Weight: Excess weight has been associated with increased risk of arthritis of the knee (and of gout, in men). If you have arthritis, maintaining your ideal weight will increase your mobility and balance and reduce the strain on your joints. Exercise Regularly: Strength training increases muscle strength and, therefore, joint support. Low-impact exercise helps improve flexibility and conditioning. And regular joint motion and weight bearing can protect against the progression of arthritis. Best of all, exercise can improve functioning without increasing symptoms. A lack of exercise, on the other hand, leads to weakening and breakdown of cartilage. Eat Right: Get at least five servings a day of fruits and vegetables, drink two to three classes of vitamin D-fortified milk, and consider a vegetarian diet.

Fiber is a King: It delays carbohydrate absorption, slows down the rise of blood sugar and so reduces the drug requirement l An intake of about 40 g dietary fibre is beneficial for diabetics. l Some high fiber foods are whole cereals like buck wheat (kootu), barley, ragey and oats, leafy vegetables, beans, whole pulses and legumes. Refined foods like Maida, Suji, Arrowroot, Sago, Juices etc are low in fibre and should therefore be avoided l

Glycemic Index or the blood glucose response of certain foods is important in deciding whether to include them or not in the meals of a person with diabetes. Foods with high glycemic index must be avoided in the diets of diabetic individuals. Foods cooked by dry and short time methods like roasting have lesser glycemic effect as compared to foods cooked by boiling and long cooking processes which reduce particle size. Preparations like roasted chanas, chapattis, sprouted dals, and whole fruits are more suitable than boiled rice, khichri, washed dals and fruit juices.

Defeat Diabetes Diabetes Mellitus is a metabolic disorder characterized by the decreased ability or complete inability of the tissues to utilize carbohydrates, accompanied by changes in the metabolism of fat, protein, water and electrolytes. The disorder is due to a deficiency or diminished effectiveness of the hormone insulin. There are two common types of diabetes mellitus: l

l

Insulin dependent diabetes mellitus (IDDM) or type I: It usually occurs before the age of 40 years. The disease usually has an abrupt onset and the abnormality of carbohydrate metabolism is severe due to lack of endogenous insulin to control blood glucose levels. These diabetics require high doses of insulin. Non-Insulin dependent Diabetes Mellitus (NIDDM) or Type II: This type usually occurs in middle life or beyond the age of 40 years, although it may also occur in the younger age group. The patients are most often obese. The onset is gradual and there is some amount though limited, of endogenous insulin.

General instruction for patients suffering from diabetes;

1. 2. 3. 4. 5. 6. 7. 8.

Keep strictly to your diet if any change is required then consult the dietician If you do not feel well or if you are in difficulty about your medicine, consult the doctor. If you are gaining or losing weight, inform your doctor Test your urine regularly and get your blood examined once a month Walk at least a mile daily. Keep your skin clean and feet dry. Avoid wearing tight shoes and socks. Consult your doctor on any skin problems. If you have any injury or you are going for an operation, declare to your doctor that you are a diabetic. If any other problem worrying you, see the social worker / counselor.

Instructions to patients taking Insulin

I. Do not alter the dose of Insulin without consulting the doctor. II. Do not allow more than an hour to elapse between a injection of Insulin and your food. III. If you get a cold, sore throat or feverish illness, do not stop taking Insulin. Take plenty of milky food instead of solids, if it is difficult to swallow. Norms for sugar level of Urine and blood Urine - Blue reduction with benedict solution Blood - Fasting and two hours after meal below 120 mg per 100 ml

Ooh, My Aching Head Do you suffer from migraine headaches? Do you suspect that your diet may have triggered them? Certain foods may be to blame, but the cause of migraines is not well understood. A migraine headache is severe, throbbing head pain, with additional symptoms such as nausea, vomiting, and increased sensitivity to light, sound and smells. An attack can last from four to 72 hours, during which time the sufferer may be forced to bed with the shades pulled down. If you have head pain, a proper diagnosis by a physician is recommended to determine the right course of treatment. Susceptibility to migraines runs in families, and is three times more common in women. Scientists suspect that an abnormal drop in serotonin, a brain chemical, causes the blood vessels to swell and causes the nerves to stimulate pain sensations. Factors such as stress, diet, menstruation, weather changes, medications, physical activity, skipped meals, extremes in food temperature, bright lights, and smoke have been known to trigger a migraine. Estrogen levels are a strong determinant of migraines; a drop in estrogen around menstruation can cause severe headaches in many women. Not every one has the same triggers, and sufferers react in different ways at different times. The migraine puzzle still needs to be solved. Ten to 30 percent of migraine sufferers can pinpoint diet triggers. Here is a list of suspected foods.

l

aged cheese -- such as cheddar and blue cheese. The amines and tyrosine are suspect.

l

chocolate

l

alcohol -- red wine, champagne, Scotch, beer. Alcohol causes the blood vessels to expand. Certain substances in wine, such as tyramine, phenols, sulfites and congeners, may be the culprits.

l

smoked or pickled meats and fish, cold cuts, hot dogs, sausage, liver -- Some migraine sufferers claim that food additives provoke the headaches. Sulfites in preserved food and MSG (monosodium glutamate) in Chinese food, restaurant food and processed foods may be suspect. Some people claim that the sweetener aspartame gives them headaches, not necessarily migraines.

l

citrus fruits, overripe bananas, sauerkraut -- high amine content

l

bouillon cubes, soy sauce, canned soups, soup mixes, marinades, meat tenderizers

l

nuts and peanut butter

l

sourdough and yeast breads

l

beans ( like broad beans, lima, soy and fava), lentils and peas

l

coffee, tea and cola

The relationship of caffeine and headaches is somewhat confusing. A small amount of caffeine can relieve a headache, but too much may bring one on. Coffee initially constricts the blood vessels, reducing the pain, but too much causes the blood vessels to dilate, causing more pain. Brewed coffee has much more caffeine than tea or cola. Some medications contain caffeine. A new pain reliever medication offers extra caffeine for migraine sufferers! Most people can tolerate one to two caffeine drinks a day. However, if you decide to cut caffeine out of your diet, do this gradually over a week. "Cold turkey" withdrawal from caffeine can give you another headache! Researchers have suspected that lower magnesium levels in relationship to higher calcium levels may cause migraines. Another study found that riboflavin, vitamin B2, reduced frequency and duration of migraines. A diet lower in fat, 20 grams of fat a day, reduced frequency by 71 percent and intensity by 66 percent in a study by Dr. Bic at the University of California at Urvine. Diet is only one of the many suspected triggers for a migraine, so do not unnecessarily restrict your diet if these are not your triggers. Keep a food diary for a month, tracking your headaches. You may be able to determine a relationship between food and headaches. A dietitian can help you plan careful menus. See your doctor for medication treatment. There are a variety of new drugs to arrest the onset, reduce the severity and relieve the pain of that throbbing migraine headache. No one has the migraine puzzle completely finished; it will take the combined efforts of sufferers, researchers and doctors to put it all together.

PREVENTION If you have a history of stone formation in a blood relation or have had a stone earlier take the following measures to diminish the chances of stone formation l l l l l l

Adequate fluid intake, ensuring 2 litres of urine daily Treat urinary infection Decrease dietary calcium; restrict intake to less than 600 mg by decreasing intake of milk products Reduce calcium absorption. Sodium cellulose phosphate, 5 g three times a day with meals, binds intestinal calcium and prevents calcium absorption Restrict protein intake to 60 to 70 g daily Urinary bladder stone is reduced by increasing phosphate excretion with pumpkin seeds, 60 mg per kg of bodyweight

BEWARE If you are a person with calcium oxalate stone and can't resist the temptation to eat an occasional strawberry or tomato, then you should drink additional water for the next day or two. Study It is claimed that milk and cheese if taken with food rich in oxalates, lead to the precipitation of non absorbable calcium oxalate in the intestines

KIDNEY STONES (Urolithiasis) Renal stone consists of mucopoly saccharides, urates, calcium oxalate, calcium phosphate and calcium carbonate. Urate and oxalate stones are most common. Cystine stones are very rare DIETETIC MANAGEMENT The fundamental principle in the treatment of kidney stone is to supply adequate fluids like water, coconut, barley water, sharbat, aerated water, fruit juice, in order to ensure the passage of 2000 ml of urine per day It is advisable to restrict foods that are rich in calcium, oxalates and uric acid. FOODS RICH IN CALCIUM, PHOSPHATE, OXALATES AND PURINES Calcium

Phosphates

Oxalates

Uric Acid

Leafy vegetables Beans Cauliflower Egg yolk Figs Milk and milk products such as cheese, yoghurt and milk fat (butter and ghee need not be restricted) Potatoes Molasses Sesame seeds Ragi

Whole cereals Legumes Nuts and oil seeds Meat Fish Eggs Milk

Leafy vegetables (Spinach) Beetroots Strawberries Tomato Tea Rhubarb Groundnuts (Peanuts) Custard apple Cocoa Chocolates Chickoo Cashew nuts Beef

Fish , Herring Fish roe Salmon Sardine Kidney Liver Meat extracts Soups Sweet bread Brain

SAMPLE DIET (VEG) PLAN FOR PATIENT WITH KIDNEY STONE Meal

Menu

Amount

Morning

Coffee or milk with sugar

1 cup

Breakfast

White bread

4 slices

Butter

2 teaspoons

Jam

2 teaspoons

Cheese

2 slices

Fruits

1 orange

Coffee

1 cup

Mid Morning

Butter milk

1 glass

Lunch

Cooked rice, or bread or chapatti (from refined wheat flour)

1 serving

Pulse soup

1 bowl

Cooked vegetables

Evening

Dinner

Fruits

1

Butter milk

1 glass

Biscuits

2

Fruit juice

1 glass

Similar to lunch

Factors leading to Hypertension Hereditary Obesity Stress and Strain Normal systolic BP - 120 to 129

Normal diastolic BP - 80 to 84 Risk Factors Coronary heart disease Male sex Cigarette smoking Increased low density lipoprotein cholesterol Obesity Foods to Avoid Meat, fish or chicken Eggs Pastries Papar, chutney & pickles Vegetables (radish, beetroot, carrot, spinach) Dried figs, raisins and sultanas Readymade curry powder Vegetable ghee, vanaspati and margarine No salt or baking soda to be used in cooking No salt permitted at the table No canned products permitted unless declared salt free.

Hypertension High blood pressure, defined as systolic pressure above 140 mm Hg and diastolic above 90 mm Hg. High blood pressure may sometimes be secondary to diseases of kidneys or endocrine glands like the ovaries, suprarenals or pituitary; this may respond to treatment of the cause. Essential hypertension is the most common disease of the industrialized societies, particularly among the middle and old age groups. It is a major contributor to the development of cardiovascular disease, stroke, and renal failure. The higher the systolic or the diastolic pressure, the greater the risk of coronary heart disease. DIETETIC MANAGEMENT Kempner advocated a rice-fruit-sugar diet for high blood pressure that gave impressive results even in severe high blood pressure. Some authorities argue that the argument was due not only to the low protein, low fat, low sodium diet, but also due to the weight loss and rest under hospital conditions. Calories An obese patient must reduce to normal bodyweight with low calorie diet as recommended for obesity. Proteins A diet of 50 grams is necessary to maintain nutrition Fats It is advisable to avoid a high intake of animal fats or hydrogenated oils (vegetable ghee, vanaspati, margarine). About 40 to 50 grams fat, partly as vegetable oil, is permitted. Carbohydrates Easily digestible carbohydrates are of great help. Minerals The micronutrients affecting blood pressure are sodium, potassium, calcium and magnesium. Sodium (salt) All patients with high blood pressure are advised to limit salt intake. Daily sodium intake: Mild low sodium diet : 2.3 grams Moderately low sodium diets :1.2 grams Restricted low sodium diets :0.6 grams Potassium (salt substitute) Dietary potassium restriction increases blood pressure in patients with hypertension. If diuretics are administered to a patient with high blood pressure, supplements of fruit juices or potassium salts, such as 2 to 4 grams potassium citrate thrice a day, are administered. Increase in potassium intake is claimed to reduce blood pressure. Calcium Higher calcium intake raises blood pressure in some people Magnesium Indications are that magnesium is necessary to regulate blood pressure.

Tips for a healthy diet Anti Aging Nutrition Secrets

Anti Aging Nutrition Secrets Feeling and looking young is more within your control than you think. Much of what we've assumed are the inevitable consequences of aging -- wrinkles, memory loss, an escalating risk for heart disease, osteoporosis and cancer -- results more from the lifestyle choices we make than from the natural aging process. And our dietary choices are just as important as using sunscreen, getting exercise and other preventive tactics. Here, your anti-aging nutritional arsenal, in a nutshell.

ANTI-AGING SECRETS

Below, a simple eating plan to stay young: Limit fat and sugar. Focus on minimally processed fruits, vegetables, whole grains, legumes, nonfat milk and lean meat, especially fish. Take a moderate-dose multiple vitamin-and-mineral supplement. Take extra antioxidants, such as 100 IU of vitamin E and up to 1,000 mg of vitamin C.

Increase certain vitamins as you age As we age, our bodies' process nutrients less efficiently, resulting in the need for us to increase our nutrient intake. For example, Vitamin D is a nutrient essential to the prevention of osteoporosis. Our bodies manufacture vitamin D when our skin is exposed to sunlight, but by our 70s our bodies produce only 40 percent of what they produced in third grade. An adequate dosage of vitamin D for people in their 20s is 200 IU; for people who are older, 400 IU to 600 IU is needed to do the same amount of work. It's impossible to say at exactly which age you should be getting this much, but because aging is a continuum, you should gradually increase your intake so that by age 60 or so you are up to around 600 IU. The need for B vitamins increases with age as well. Three B vitamins -- folic acid, vitamin B6 and vitamin B12 -- are essential for keeping levels of a compound called homocysteine low in the blood; if allowed to rise, homocysteine contributes to heart-disease risk and possibly memory loss, according to a study in a 1998 European Journal of Pediatrics. As you age, increase your B6 dose from 2 mg to 5 mg; increase B12 over time from 2 mcg to 10 mcg. Women should take 400 mcg of folic acid daily; pregnant women should take 800 mcg daily (to help prevent neural-tube defects in the fetus). Women, in particular, should be aware that their calcium intake should increase as they age to prevent osteoporosis: According to the National Institutes of Health, during the middle years, 1,000 mg each day is adequate; 1,200 mg after menopause if you're on hormone replacement therapy; 1,500 mg if you are not on HRT. (During adolescence, girls should take 1,200 mg to 1,300 mg.)

Consume "anti-aging" produce People who consume diets loaded with fresh fruits and vegetables have lower disease rates, more energy and less risk for weight gain (which can lead to health problems) than those who skip these foods, according to numerous studies published over the years. What's the magic ingredient in fresh produce? There are several: With the exception of avocados, olives and coconuts, fresh fruits and vegetables have no fat, cholesterol or sodium. They are also fiber-rich: Eight servings of fruits and vegetables daily supplies approximately 27 grams of fiber, well within the daily target goal of 25 grams to 35 grams. Fiber-rich foods lower a person's risk for developing age-related diseases such as heart disease, cancer, diabetes and hypertension. Fiber-rich foods also are low in calories, yet satiating, so they help fill you up without filling you out. Fresh fruits and vegetables are nutrient-packed, providing ample amounts of calcium, iron, magnesium, vitamin C, beta carotene and folic acid, and they are low in calories (a heaping bowlful of greens supplies only 30 calories!). The National Cancer Institute recommends a minimum of five fruit-and-vegetable servings a day, but research shows that the more servings, the greater the health benefits. Therefore, to fend off the hands of time, you should try to consume at least eight servings of fruits and vegetables each day (two at every meal and two as snacks).

Load up on age-defying antioxidants Fruits and vegetables also are gold mines of longevity-enhancing compounds called antioxidants; these include vitamins C and E and beta carotene. Antioxidants combat free radicals, oxygen fragments that attack and damage cell membranes, life-sustaining proteins and even our cells' genetic code, and in so doing bring about aging and disease. Diets rich in antioxidants prevent disease and premature aging. Antioxidants also stimulate the immune system and protect the nervous system and brain from the oxidative damage associated with age-related memory loss. A 1993 Harvard School of Public Health study found that adults who supplemented daily with at least 100 IU of vitamin E for at least two years had up to a 40 percent reduction in heart-disease risk. Men, in particular, can benefit from the immune-enhancing effects of antioxidants: A study published in this month's Journal of the National Cancer Institute found that men who consumed vitamins C and E had lower amounts of certain particles (androgens, for example) associated with the development of prostate cancer. The recommended daily value (RDA) for vitamin C is 60 mg, but up to 1000 mg can be taken safely.

Practice portion control and make every bite count Cut back on unnecessary calories, and you stack the deck in favor of living longer. Studies of small mammals have shown that in every case these animals have increased their lifespan from two- to four-fold by cutting back on food intake. Such animals have lower rates of all age-related diseases, including heart disease, diabetes, cancer, memory loss and dwindling immunity. Don't confuse reducing calories with malnutrition, however. Lower your intake of foods containing fat and sugar but continue to eat foods chockful of nutrients including fruits, vegetables, whole grains, legumes and nonfat milk products.

Get your fat from fish Last but not least, get your fat from fish, not from red meats. The fats in fish, called omega-3 fatty acids, lower heart-disease risk, stimulate the immune system and might even reduce the incidence of depression. In a study published in this month's American Journal of Clinical Nutrition, researchers from the University of Barcelona found that "fish-lovers" have a significantly reduced rate of colorectal, esophageal, stomach and pancreatic cancers. Even small amounts of fish were found to lower risk for cancers of the digestive tract. The researchers speculate that the fatty acids found in fish may help inhibit the growth of cancer cells.

for Healthy diet

Tips for a healthy diet Anti Aging Nutrition Secrets The food you eat is crucial to virtually every bodily process and function. It paves the way for you to have a healthy baby, helps to prevent or promote disease, may sharpen or weaken mental acquity, may even affect your mood. Many factors are involved in answering the question "what should I eat?". But here are some basic pointers to keep in mind - before you open your mouth

THE EIGHT POINT PLAN: n

Eat plenty of fiber, pulses, whole grains, foods made with wholegrain flour (such as wholegrain bread), and fruit and vegetables give you the benefit of fiber as well as its associated essential fatty acids, minerals, and vitamins. Grains are better only coarsely ground.

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Eat plenty of fresh fruit and vegetables, especially green leafy ones. These give you the vitamins, minerals, essential fatty acids and fiber you need. Peel the fruit as little as possible (peel and pith are nutrient rich). Cook vegetables lightly by steaming or stir frying, and eat some raw everyday to benefit from their hormones and enzymes.

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Cut down your fat intake ( especially saturated fat ). Choose fish, offal (organ meat), game, poultry, whole grains, pulses, nuts and seeds, or sprouted seeds, rather than red meat and cheese.

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Cut down your sugar intake. Use sugar as flavoring rather than as a food. Avoid cakes, sweets, chocolates, biscuits, puddings, ice-creams, jam, fruits canned in syrup, soft drinks, sugar in tea and coffee, and milk shakes.

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Cut down your salt intake. Instead of adding salt to your food use herbs, spices, fresh ginger, horseradish, lemon juice, tomato puree, vinegar, soy sauce, vegetable stock, yeast extract, chutney, and other flavorings.

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Cut down your consumption of processed food to avoid the " empty calories" of saturated fats, added sugar, refined cereal grains, and additives.

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Drink only moderate amounts of alcohol.

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If you are overweight, exercise more and consume the amount of food and drink that will enable you to reach and keep to your optimal body weight

Iron What does it do? Iron is part of hemoglobin, the oxygen-carrying component of the blood. Iron-deficient people tire easily because their bodies are starved for oxygen. Iron is also part of myoglobin, which helps muscle cells store oxygen. Without enough iron, ATP (the fuel the body runs on) cannot be properly synthesized. As a result, some iron-deficient people become fatigued even when their hemoglobin levels are normal. Although iron is part of the antioxidant enzyme catalase, iron is not generally considered an antioxidant, because too much iron can cause oxidative damage. Where is it found? The most absorbable form of iron, called “heme” iron, is found in oysters, meat, poultry, and fish. Non -heme iron is also found in these foods, as well as in dried fruit, molasses, leafy green vegetables, wine, and most iron supplements. Acidic foods (such as tomato sauce) cooked in an iron pan can also be a source of dietary iron. Who is likely to be deficient? Vegetarians eat less iron than nonvegetarians, and the iron they eat is somewhat less absorbable. As a result, vegetarians are more likely to have reduced iron stores. However, iron deficiency is not usually caused by a lack of iron in the diet alone; an underlying cause, such as iron loss in menstrual blood, often exists. Pregnant women, marathon runners, people who take aspirin, and those who have parasitic infections, hemorrhoids, ulcers, ulcerative colitis, Crohn’s disease, gastrointestinal cancers, or other conditions that cause blood loss or malabsorption are likely to become deficient. Individuals who fit into one of these groups, even pregnant women, shouldn’t automatically take iron supplements. Fatigue, the first symptom of iron deficiency, can be caused by many other things. A nutritionally oriented doctor should assess the need for iron supplements, since taking iron when it isn’t needed does no good and may do some harm. How much is usually taken? If a nutritionally oriented doctor diagnoses iron deficiency, iron supplementation is essential. A common adult dose is 100 mg per day. When iron deficiency is diagnosed, the doctor must also determine the cause. Usually it’s not serious (such as normal menstrual blood loss or blood donation). Occasionally, however, iron deficiency signals ulcers or even colon cancer. Many premenopausal women become marginally iron deficient unless they supplement with iron. Even so, the 18 mg of iron present in most multiple-vitamin/mineral supplements is often adequate. Are there any side effects or interactions? Huge overdoses (as when a child swallows an entire bottle of iron supplements) can be fatal. Keep iron-containing supplements out of a child’s reach. Hemochromatosis, hemosiderosis, polycythemia, and iron -loading anemias (such as thalassemia and sickle cell anemia) are conditions involving excessive storage of iron. Supplementing iron can be quite dangerous for people with these diseases. Supplemental amounts required to overcome iron deficiency can cause constipation. Sometimes switching the form of iron, getting more exercise, or treating the constipation with fiber and fluids is helpful. Sometimes the amount of iron must be reduced if constipation occurs. Some researchers have linked excess iron to diabetes, cancer, increased risk of infection,4 systemic lupus erythematosus (SLE), exacerbation of rheumatoid arthritis, and heart disease, though a review of the best studies has found no link. 10 None of these links has been proven. Nonetheless, too much iron causes free radical damage, which can cause or exacerbate most of these diseases. People who are not iron deficient should not supplement iron when potential risks might exist and no benefit can be found. Caffeine, high-fiber foods, and calcium supplements reduce iron absorption. Vitamin C slightly increases iron absorption. Taking vitamin A with iron helps treat iron deficiency, since vitamin A helps the body use iron stored in the liver. Deferoxamine is a drug that binds to some metals, including iron, and carries them out of the body. It is used to treat acute iron poisoning, chronic iron overload, and aluminum accumulation in people with kidney failure. People taking deferoxamine to treat iron overload must not take iron supplements, including the amounts found in many multivitamin/minerals. Penicillamine binds metals (including copper and iron) and carries them out of the body. When penicillamine and iron are taken together, penicillamine absorption and activity are reduced. Four cases of penicillamine-induced kidney damage were reported when concomitant iron therapy was stopped, which presumably led to increased penicillamine absorption and toxicity.

Calcium What Is It? Calcium is an element founds in bones, shells and limestone, among other materials. What Does It Do? Calcium, along with vitamin D, helps build and maintain healthy bones and teeth. In addition, calcium: l l l l l l l

helps lower blood pressure and control heartbeat helps regulate muscle contractions plays a role in blood clotting prevents fatal bleeding from breaks in the walls of blood vessels maintains cell membranes aids in the absorption of vitamin B12 activates enzymes such as lipase, the fat-splitting enzyme

Your bones furnish reserves of calcium to keep plasma constant at all times. Where Do We Get It? Dairy products are the preferred sources of calcium. Children need 3 servings a day whereas pre-teens, teens and older adults need four servings a day. The following foods provide about 400 milligrams of calcium:

l l l l l

Sardines with bones -- 3 1/2 ounces Yogurt, plain low-fat with milk solids added -- 1 cup Yogurt, plain nonfat -- 1 cup Tofu processed with calcium salts (content of tofu varies widely so consult label) Cafe latte -- 12 ounces

300 milligrams of calcium: l l l l l l l l

Milk -- 1 cup, any kind Yogurt -- 1 cup Cheese -- 1 1/2 to 2 ounces Part-skim ricotta cheese -- 1/2 cup Salmon, canned with bones -- 6 ounces Collard greens -- 1 cup cooked frozen Soy milk -- 1 cup, varies with brand Fortified orange juice -- 1 cup

200 milligrams of calcium: l l l l

Cheese -- 1 ounce (cheddar, part skim mozzarella, provolone, process American or swiss) Ice cream or ice milk -- 1 cup Turnip greens or kale -- 1 cup cooked Cheese pizza -- one slice

100 milligrams of calcium: l l l l l l l l

Cottage cheese -- 3/4 cup low-fat or creamed Broccoli -- 1 cup cooked, frozen Navy or pinto beans -- 1 cup cooked Taco -- one small English muffin -- 1 Almonds -- 1/3 cup Figs, dried -- 4 Frozen yogurt -- 1/2 cup

50 milligrams of calcium: l l l l l

Black beans or lima beans -- 1 cup cooked Clams,canned -- 2 ounces Shrimp -- 3 ounces canned or 4 1/2 ounces fresh, steamed Hamburger bun -- 1 Orange -- 1

How Much Do We Need? Most adults need 1,000 milligrams a day; adults over 50 need 1,200 milligrams. Children and adolescents need 1,300 milligrams to build and grow strong bones and calcium stores. Pregnant and breast-feeding women need only the amount recommended for their age. Most Americans do not get enough calcium in their diets, especially women. When calculating the amount of calcium you get in your diet, keep in mind that certain dietary factors, lifestyle characteristics, medical conditions and medications can affect the absorption or excretion of calcium in your body. For example: l

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Calcium from foods rich in oxalates (such as spinach, sweet potatoes and beans) or in phytates (such as whole wheat bran, beans, nuts and soy isolates) may be absorbed poorly. Protein and sodium in foods boost the amount of calcium excreted in urine, while phosphorus an vitamin D reduce the amount excreted in urine. Caffeine reduces the absorption of calcium. Cigarette smoking may decrease the absorption o calcium. Diseases such as hyperthyroidism and diabetes, and medicines such as corticosteroids and glucocorticoids reduce the absorption of calcium, and increase the amount excreted in urine. Alcohol in moderation does not appear to adversely affect calcium availability.

If you are not getting enough calcium in your diet, you should take a supplement. They do not provide the same overall nutrient benefits as foods, however. If you do take calcium supplements, follow these guidelines. l l l l

If you take high amounts, be sure to get at least 18 milligrams of zinc per day, too. Avoid supplemental calcium from sources such as dolomite, oyster shell and bonemeal, which may be contaminated with lead or arsenic. Take supplements with meals, and spread the daily dosage out over several meals instead of taking it all at once. Read labels carefully; not all supplements contain the same amount of calcium. Supplements made from calcium carbonate have the most; 40 percent of the pill is the calcium itself. This number drops to 38 percent for pills made with calcium phosphate, to 21 percent for pills with citrate, and to 13 percent for lactate and 9 percent for gluconate. So you would have to make many more calcium lactate pills than calcium carbonate pills to get the same amount of calcium.

Is It Safe? A calcium intake of up to 2,500 milligrams is safe for healthy people.

Fibre What is it ? Dietary fibres are structural components of plants. The type and amount of fibre in plants vary from species to species. A common misconception about fiber is that it is not digested by enzymes in the body and therefore provides no calories or nutrients. But the category "fibre" includes chemicals that are not fibrous, materials that can be dissolved, and some substances that can be digested partially. We eat quite a complex mixture of fibers. Dietary fibre is a broad generic term; it includes the following chemicals, which form the structural components of plants, including many of the plant foods we eat: l l l l l l

cellulose hemicellulose lignin pectin's mucilage's gums

The first three are insoluble fibers which can absorb and hold water in the digestive system. The others are soluble fibers, which are partially broken down in digestion to a gel-like substance, which also retains water. What does it do? Fiber's ability to hold water and to bind minerals and cholesterol-like materials results in a number of physiological effects which vary depending on the type of fiber and/or where it is in the digestive tract.

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In the mouth, fiber stimulates the flow of saliva. In the stomach and small intestine, fiber dilutes the contents and delays the emptying of food and the absorption of nutrients; this promotes a feeling of fullness. In the large intestine, fiber dilutes the contents and provides a place for bacterial growth and digestion. The water-holding capacity of insoluble fiber in the lower intestine softens the stool and increases stool size, so that the process of elimination is easier and faster. In the large intestine, fibre also acts to bind certain chemicals. Different kinds of fiber have different binding capacities: when fiber binds cholesterol- like compounds, it lowers cholesterol, a healthy result; when fiber binds minerals, it decreases their absorption, a less desirable result.

Because of these physiological effects, fiber is considered beneficial in preventing, alleviating or curing a number of diseases and conditions, including: l l l l l l l

arteriosclerosis (hardening of the arteries) excess food intake diverticular disease irritable bowel syndrome Crohn's disease gallstone formation constipation

Where do you get it? Recent recommendations suggest that we should be getting fiber from a variety of foods high in different types of fibers, rather than from dietary supplements. A healthy diet should provide a mixture of both soluble and insoluble fibers. About eight grams of daily fiber intake should be in the form of soluble fibers, such as: l l l

fruits, especially apples and citrus vegetables, especially leafy green varieties oats

Major sources of insoluble fibers include: l l l l

wheat bran whole grains legumes most fruits and vegetables

A good source of fiber should have at least three grams of fiber. High-fiber foods provide five grams or more. The accompanying chart lists a variety of foods and their fiber content. Sources of Fibre

Food

Amount of fibre (in gms) in a 100g (3.5 ounce) serving

bagel

2.1

bran bread

8.5

pita bread (white)

1.6

pita bread (whole white)

7.4

white bread

1.9

Bread

Cereals bran cereal

35.3

bran flakes

18.8

cornflakes

2.0

oatmeal

10.6

wheat flakes

9.0

barley, pearled (minus its outer covering)

15.6

cornmeal, whole grain

11.0

de-germed

5.2

oatbran, raw

6.6

rice, raw (brown)

3.5

rice, raw (white)

1.0-2.8

rice, raw (wild)

5.2

wheat bran

15.0

apple (with skin)

2.8

apricots (dried)

7.8

figs (dried)

9.3

kiwifruit

3.4

pears (raw)

2.6

prunes (dried)

7.2

prunes (stewed)

6.6

raisins

5.3

Grains

Fruits

Vegetables beans l

baked (vegetarian)

7.7

l

chickpeas (canned)

5.4

l

lima, cooked

7.2 broccoli, raw

7.7

brussels sprouts, (cooked)

2.6

cabbage (white) raw

2.4

cauliflower, raw

2.4

corn, sweet, cooked

3.7

peas with edible pods, raw

2.6

potatoes, white, baked, w/skin

5.5

sweet potato, cooked

3.0

tomatoes, raw

1.3

corn chips, toasted

4.4

Others

nuts 11.2

l

almonds,oil-roasted

l

coconut,raw

9.0

l

hazelnnuts,oil-roasted

6.4

l

peanuts,dry-roasted

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pistachios

8.0 10.8

tahini

9.3

tofu

1.2

Source: Provisional table on the dietary fibre content of selected foods (Washington, D.C.: U.S. Department of Agriculture,1988).

How much do we need? A healthy adult should get 20-25 grams of fiber a day, based on the assumption that we need 10-13 grams of fiber a day for every 1,000 calories consumed. Unfortunately, most Americans consume only about 10 grams. Children ages 3-18 need less fiber than adults, and they need different amounts at different ages. To calculate a child's daily fiber requirements, add the child's age to the number five (for five grams). For example, a four-year-old needs nine grams of fiber a day. To get the appropriate amount of fiber, adults should include the following in their diets: l l l

two to three servings of whole grains (as part of the 6-11 recommended daily servings) five servings of fruits and vegetables a day one or two servings of legumes every week

Is it safe? Yes. However, increasing your fiber intake to recommended levels may cause some unpleasant effects unless you do it gradually and drink plenty of water. This can help you avoid: l l l

gas, distention and/or diarrhea resulting from increases in fiber intake colon obstruction caused by very large intakes of fiber interference with the absorption of some minerals (though this should not be a problem if you eat a healthy diet.)

FAT fighters Drop pounds effortlessly and deliciously -- simply by eating these weight loss catalysts Food

How they help you lose?

SWEET POTATOES

Their high fibre and high and complex carbohydrate content helps regulate blood sugar levels and satisfy the appetite. They are also loaded with cancer fighting vitamin A

LEAFY GREENS (Drumstick leaves, amaranth, spinach)

They fill you up with fibre and not many calories. And the fuller you are, the less room for higher calorie foods. They are also a great source of vitamins and minerals.

LEAN PROTEINS (skinless chicken, fish, egg whites)

Some people feel more satisfied after a meal that includes small amounts of high protein foods.

FRUITS (Apples, grapes, mangoes, guavas, papaya, etc)

Sweet and easy to eat, fruits fill the void between meals, and offer a satisfying substitute for the desserts such as cakes and cookies. They are also a great source of insoluble fibre (which helps prevent constipation ), pectin (a fibre component that fights cholesterol), and many antioxidants.

VEGETABLES (Carrots, cabbage, lady finger, french beans, beets etc)

Veggies provide the crunchy sensation we miss when we cut down snacking on high calorie items. They are loaded with fibre, vitamins and minerals.

WHOLE GRAINS (Brown rice, barley, bulgur wheat)

Their chewy texture helps slow down your eating while filling you up with fibre. The nutty flavour helps satisfy your taste buds

BEANS AND LEGUMES

A fabulous source of fibre and protein, beans are an excellent main dish substitute for higher fat animal proteins.

Vitamin C (Ascorbic Acid) Vitamin C is a popular vitamin and widely used supplement. Also named ascorbic acid, vitamin C is currently being studied for its anti-oxidant effects that may prevent certain diseases. Deficiencies of vitamin C are rare in the United States today because foods rich in vitamin C are widely available. A severe deficiency can lead to scurvy, a disease that causes loose teeth, excessive bleeding and swollen gums. Wound healing can be reduced. The current Recommended Dietary Allowances are 60 mg a day, but researchers are suggesting an increase to 200 mg a day. What Does Vitamin C Do? l

Helps form the protein collagen. Collagen is the connective tissue that holds together muscles, bones, teeth, skin, cartilage and scar tissue.

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Helps keep capillary walls and blood vessels firm, protecting you from bruising.

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Iron from plant sources is more readily absorbed when vitamin C is present.

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Keeps gums healthy.

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Helps wounds heal quickly.

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Improves immune system health.

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Involved in the synthesis of neurotransmitters in the brain..

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It is an important antioxidant in prevention of heart disease, cancer and cataracts. Vitamin C attacks free radicals in body fluids, not fat tissue, since it is a water-soluble vitamin.

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May interfere with the oxidation of LDL cholesterol and reduce atherosclerosis.

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May reduce the severity and duration of a cold. Contrary to popular knowledge of Linus Pauling’s megadosing strategies, researchers in 12 welldesigned studies were unable to prove and preventive effect of vitamin C on the common cold.

Vitamin C in Our Food The current RDA is 60 mg and can easily be obtained through diet. Rich sources are citrus fruits, broccoli, cantaloupe, Brussels sprouts and strawberries. Many drinks are now fortified with vitamin C. Vitamin C is most exclusively found in plants with a small amount found in milk. Vitamin C is delicate, and the content of the vitamin in a food can be enhanced with the following tips: l l l l l l l l l l l l

Store food in a cool, moist place. Use as soon as possible. Vegetables lose vitamin C during long storage, but not the root vegetables. Harvest at the peak of maturity. Limit exposure to air and sunlight. Avoid soaking the food in water for long periods. Cook food in minimal amounts of water. Microwave cooking preserves the vitamin C because water is not added. Cook food in largest pieces possible. Heat reduces some of the content of vitamin C in food. Freeze-drying of fruit cues minimal loss of Vitamin C. Frozen and canned foods, picked at the prime and optimally processed, may have more vitamin C than fresh produce that has been stored for a long time with poor temperature and humidity conditions.

Vitamin C Content of Selected Foods Food

Mg Vitamin C

Papaya (1)

187

Cantaloupe (1/2)

113

Fresh orange juice (3/4 cup)

93

Orange (1)

70

Grapefruit juice (3/4 cup)

71

Sweet red pepper (1/2 cup)

95

Green pepper (1/2 cup)

66

Broccoli, cooked (1/2 cup)

58

Brussels sprouts, cooked (1/2 cup)

48

Grapefruit (1/2)

47

Watermelon (1-inch slice)

46

Strawberries (1/2 cup)

42

Cauliflower, cooked (1/2 cup)

27

Cabbage, raw (1 cup)

22

Baked potato (1)

26

Fortified foods

100 to 200

Supplementation Many people believe in the benefits of supplementation of vitamin C, sometimes as high as 3000 mg a day. Large amounts of vitamin C can cause nausea, abdominal cramps, diarrhea and nose bleeds. Is it your cold or vitamin C making you feel this way?

Researchers disagree as to whether large doses of vitamin C cause kidney stones. People with hemchromatoses (iron overload) are cautioned not to take vitamin C supplements, but this recommendation is challenged in research studies. Vitamin C supplementation is recommended for groups with special considerations because the vitamin C is depleted in fighting the free radicals. Smokers, people with poor dietary intake, oral and other surgery patients, pregnant women, children with poor diets, elderly people, and people with inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease should consider taking supplements. If 2000 mg of vitamin C is taken one hour before exercise, it can reduce lung discomfort and wheezing in people with asthma. Dr. Losonszy at the Nation Institute for Aging found that older persons taking supplements of vitamin C and E have half the risk of dying a premature death. Dr. Mark Levine at the National Institute of Health has studied the saturation level of vitamin C and has determined that 200 mg a day saturates the body’s tissues. Additional intake causes a rise in urinary excretion. It appears that an optimal daily goal for vitamin C intake from diet and supplements (if diet is lacking) is between 60 and 200 mg a day. No harmful effects have been indicated for levels of 500 to 1000 mg a day. Research continues to evaluate any pro-oxidant as well as anti-oxidant effects vitamin C may have on our health.

Vitamin K What is it? Vitamin K is a fat-soluble vitamin that comes in many forms. It consists of a group of compounds called vitamin K1, K2, K3 or K4. These compounds occur in a variety of natural and laboratory environments. l l l l

K1 (phylloquinone) is present naturally in plants. K2 (menaquinone) is made by bacteria in the intestinal tract of humans and animals. It is about 75 percent as active as K1. (K2 is a whole family of compounds including menaquinone-4 and MK5 through MK13.) K3 (menadione) is man made. K4 (menadiol) is man made. It can be used by intestinal bacteria to make K2. Unlike the fat-soluble compounds K1, K2 and K3, K4 is water-soluble.

What does it do? Vitamin K protects us from bleeding excessively due to cuts and wounds or due to internal bleeding. It is used by the body in blood clotting and in the formation of prothrombin and other blood-clotting proteins. Vitamin K is also required for the biosynthesis of some proteins found in plasma, bone and kidneys. Where do you get it? The vitamin K in most foods is low -- less than 10 micrograms per 100 grams. Most vitamin K from food sources is obtained from leafy green vegetables (such as those in the accompanying chart) and from four vegetable oils, including olive oil and soybean oil. Beef liver and green tea are also sources of vitamin K. Leafy Green Vegetables: Sources of Vitamin K Food

Micrograms of Vitamin K*

Kale

278

Swiss chard

149

Spinach

112

Broccoli

90

Red leaf lettuce

59

*based on 1/2 cup servings Even though the absorption of vitamin K from food is relatively low, a typical mixed diet in the U.S. provides about 400 micrograms a day. How much do we need? The current Recommended Dietary Allowance (RDA) for vitamin K is one microgram per kilogram of bodyweight. For adults, this represents about 65 to 80 micrograms a day; young adults usually take in around 80 micrograms a day, and older people consume about 150 micrograms a day. Recent research suggests that getting 420 micrograms a day increases the bone-building proteins in the blood. There is no reason for healthy people to self-prescribe oral supplements of vitamin K. Vitamin K deficiency is a risk for: l l l

adults with long-term antibiotic intakes people with lipid malabsorption syndromes newborn infants (which is why they are given injections of vitamin K after birth)

Is it safe? No upper limit has been set for safe ingestion of vitamin K, and no toxic effects have been observed due to large amounts of vitamin K being ingested over long periods of time. However, under certain circumstances, vitamin K can be problematic: l l

People who take coumadin need to be carefully monitored. Vitamin K combined with high intakes of vitamin E can produce hemorrhage, especially for people who also take anticoagulants.

Vitamin E (Tocopherol) Benefits: The evidence keeps piling up -- vitamin E, although rarely deficient in people in our society, has additional benefits in higher-than-dietary doses. Vitamin E protects the heart, improves the immune system, protects against cataracts and may even be of service in the fight against cancer and Alzheimer's Disease. What is Vitamin E? A fat soluble vitamin, vitamin E is dissolved in fat, and is carried throughout the bloodstream and body attached to lipids. It is stored in adipose tissue, so a daily dose is not critical. As opposed to other fat soluble vitamins like A and D, vitamin E has not been shown to be toxic in high doses. People on anticoagulant therapy, however, such as those who take the medication Coumadin, should be cautious about vitamin E intake. They may be increasing their risk of bleeding if they are also taking high doses of vitamin E, and/or fish oil tablets. Vitamins E is actually a group of substances known as tocopherols and tocotrienols. The amount of vitamin E present in food or tissue is stated in terms of alpha-tocopherol equivalents (TE) or as International units (IU). Alpha tocopherol is the most potent form, as compared to the beta, gamma, and delta tocopherol forms. Research indicates that natural vitamin E is more potent and also better retained by the body than synthetic E. How Much do I Need? The adult RDA is 8 to 10 milligrams of vitamin E. This is easy to achieve with diet alone. However, there is considerable research that suggests supplemental vitamin E for its antioxidant protection, at levels of 100 to 400 IU. Following a low-fat diet would make this level difficult, and copious amounts of oil would need to be consumes to reach these therapeutic levels. What are Food Sources of Vitamin E?

Vitamin E in Foods Food

Portion

Vit E (IU)

wheat germ oil

1 tablespoon

25

sunflower seeds

1 ounce

21

almonds

1 ounce

11

sunflower oil

1 tablespoon

10

safflower oil

1 tablespoon

8

soybean oil

1 tablespoon

2

peanuts

1 ounce

3

avocado

1 medium

3

spinach

1 cup (raw)

2

What Health Problems are Aided by Vitamin E? l

Heart Disease -- Vitamin E has a strong protective role in the reduction of atherosclerosis by preventing oxidation of LDL cholesterol. This antioxidant activity discourages the buildup of plaque on artery walls and the formation of blood clots that cause heart attacks and strokes.

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Cancer -- Free radicals play a role in the initiation and promotion of cancer. Studies show that cancer risk is lower in people with the highest vitamin E intake.

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Immune System -- Researchers suggest that vitamin E can boost immunity by protecting against cell damage that reduces the body's ability to fight infection. This is particularly important in the elderly. Vitamin E may also play a role in delaying the advance of Alzheimer's Disease.

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Cataract Risk -- The antioxidant activity of vitamin E can reduce cataract risk by 50 percent or more, as reported by the Longitudinal Study of Cataract Group as well as other investigations.

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Air Pollution -- Whether it be smog or smoking, the free radical destruction of red blood cells is protected by vitamin E supplementation.

Research continues to demonstrate the antioxidant protection of vitamin E from free radical damage that is the beginning of major degenerative diseases. Most studies use supplementation of 100 IU to 400 IU of vitamin E to get positive results. Larger amounts did not exhibit greater benefits. Vitamin E will not cure everything, but in doses larger than the RDA, it is not harmful and potentially beneficial.

Vitamin D What Is It? Vitamin D is a fat-soluble vitamin. Our bodies can manufacture it when our skin is exposed to sunlight. What Does It Do? The most important thing vitamin D does is to maintain blood levels of calcium within normal limits. It does this by regulating the way the intestines absorb calcium and phosphorus from food. Without vitamin D, a deficiency of dietary calcium will cause the body to rob the bones of calcium to maintain appropriate calcium blood levels. Vitamin D also may reduce the risk of colon cancer, breast cancer and arthritis. Studies to investigate these possible benefits of vitamin D are under way. Where Do You Get It? Most foods have little or no vitamin D, and few foods besides milk are fortified with it. So where do we get the vitamin D that is necessary to maintain blood levels of calcium? Actually, our bodies can manufacture vitamin D for us when the skin is exposed to adequate sunlight. Here's how it works: 1. High-energy ultraviolet light penetrates the skin. 2. The UV-B converts a precursor in the body into a form of vitamin D. 3. The liver and kidneys act on this substance to turn it into the active form of vitamin D. To ensure that this important process occurs, you need to expose your hands, face and arms to the sun for 10-15 minutes, two or three times a week, between 8 a.m. and 4 p.m. (The exact amount of time you need depends on the sensitivity of your skin to sunburn and on your latitude.) Using sunscreen during this brief period may interfere with the process. Although not many foods are fortified with vitamin D, those that are can provide some of (and in the case of milk, a great deal of) the vitamin D you need. l l l

Milk leads the list, with 100 IU (international units) per cup. Some cereals and breads are fortified with small amounts of vitamin D, up to 15 IU. Margarine is fortified with 20 IU per teaspoon.

Other foods that contain vitamin D: l l l

Cod liver oil contains vitamin D, but in excess it leads to toxic levels of Vitamin A. Some fatty fish are sources, but unless you eat them often you will not get enough. Eggs provide a little vitamin D (27 IU).

People sometimes mistakenly think that some foods that contain milk have vitamin D. Remember that these dairy products do not contain vitamin D: l l l

ice cream cheese yogurt

Multivitamins or other supplements are a source of vitamin D (200400 IU). Many calcium supplements have extra vitamin D added (100125 IU per tablet). Note: If you are taking a supplement blend, read the label carefully. If the ingredient list includes "core level products" or "glandular tissue," do not take it. It may contain excessive amounts of vitamin D. How Much Do We Need? l l l

If you are under 50 years of age, 200 IU of vitamin D a day are enough. If you are 5170, you need 400 IU daily. If you are over 70, you need 600 IU of vitamin D every day.

Not getting enough vitamin D can cause serious health problems, including: l l l l

rickets in children osteomalacia, a mineralization defect in adults the acceleration of bone loss and risk of fracture in adults, especially in post-menopausal women arteriosclerosis, or hardening of the arteries

Is It Safe? Excess vitamin D is toxic. You should get no more than 1,000 IU per day from milk, food and supplements. The very upper limit of safe intake from these sources is 2,000 IU daily. Too much vitamin D causes birth defects. It also can lead to excessively high blood calcium levels, which could cause calcium deposits in the kidneys and arteries.

What is it? Vitamin A is a fat-soluble vitamin which comes in two forms. The first is retinol, which is found already pre-formed in animal foods. The other is pro-vitamin A, which is found in plant foods in the forms of compounds called carotenoids. The best known and most prominent carotenoid is beta-carotene, which provides about two-thirds of vitamin A in our diets. Beta-carotene is not as well absorbed as retinol, and it is only about half as active in vitamin activity. Other carotenoids are even less active than beta-carotene. What does it do? Vitamin A is needed to: keep skin and tissue linings healthy maintain vision and eye structure help resist infection develop bones properly form sperm maintain a healthy fetus during pregnancy

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Where do you get it? The main sources of pre-formed vitamin A are animal foods, including: liver and organ meats fish liver oils fatty fish whole milk and butter egg yolks

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Vitamin A is also found in: low-fat and skim milk margarine vitamin-fortified cereals

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Vitamin A: Good sources Food

Amount

Retinol Equivalents (RE) (approximate)

Beef liver

3 ounces

9,085

Sweet potato

1/2 cup, mashed

2,800

Carrot

1 medium

2,025

Kale, boiled

1/2 cup

480

Mango

1/2

405

Spinach, raw

1/2 cup

375

Milk, skim

1 cup

150

Milk, whole

1 cup

75

Egg

1 large

95

Romaine lettuce

1 cup

145

How much do we need? Vitamin A is often measured in retinol equivalents -- RE, for short. The Recommended Daily Allowance, or RDA, is: l l

1,000 RE for boys and men 800 RE for girls over 12 and adult women (1,300 RE if breast-feeding)

Vitamin A also can be measured in international units, which is abbreviated as IU. This is how it is normally measured for food labels and supplements. To calculate IU, multiply the RE number by 5. For example, a male needs 5,000 IU. If you are considering vitamin A supplements, keep in mind that deficiency is extremely rare in the U.S. and that there are health risks associated with taking too much. Is it safe? In excessive amounts, vitamin A can be toxic. The use of high-potency vitamin supplements, fad diets, and the tendency to over- and self-medicate have led to many cases of vitamin A intoxication. Acute toxicity results from extremely high doses (500,000 IU) of vitamin A consumed over a short period of time. The symptoms include nausea, headache, bone pain, blurred vision and flaking skin. The symptoms resolve if the high doses are discontinued. Chronic toxicity may occur in adults with long-term intakes of 25,000 IU per day. Symptoms include headache, bone thickening, anemia, enlarged liver and spleen, menstrual abnormalities, stiffness and joint pain. These are some specific conditions under which vitamin A may be toxic, even in relatively low doses. l

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Recently, concerns have arisen that the level of vitamin A in multi-vitamin supplements (5000 IU) may be associated with abnormal liver function tests in the elderly. Vitamin A in excess is also capable of causing birth defects, including deformities of the head, heart, brain or spinal cord. The vitamin A analogue used to treat skin disorders like acne may be problematic in this regard, and those who use it should be careful to avoid pregnancy. Pregnant women should never exceed 5,000 IU a day and should get most of their vitamin A from food sources -- liver, fortified cereals and carrot

juice -- to avoid excessive intakes. Amounts around 10,000 IU could cause birth defects. As far as supplements are concerned, women who are pregnant -- or planning to be -- should avoid supplements with more than 5,000 IU of vitamin A. In fact, supplements should be avoided altogether during the first trimester of pregnancy unless they are needed to correct a deficiency. Women of child -bearing age should choose fortified foods that contain vitamin A in the form of beta-carotene, rather than pre-formed vitamin A, whenever possible. There is no risk in eating lots of fruits and vegetables that are rich in beta-carotene and other carotenoids, and it should be encouraged. What about beta-carotene? Beta-carotene is the most abundant of the carotenoids that the body converts to vitamin A when we eat foods rich in carotenes. The liver makes only the amount of vitamin A needed by the body. Beta-carotene is an anti-oxidant that neutralizes the "free radicals" in your blood. Left unchecked, these highly reactive compounds can damage tissues and cells and possibly lead to diseases such as cancer and heart disease. More than 200 studies suggest beta-carotene plays a role in cancer prevention. One study in China showed beta-carotene decreases risk of stomach cancer if it is combined with other anti-oxidants such as vitamin E and selenium. Conflict about beta-carotene arose when recent major studies provided conflicting and problematic results. In one study, men who smoked or were heavy drinkers took 30-50 milligrams of beta-carotene and had an increase in the risk of lung cancer. Another study tracked a large group of doctors who took 50 milligrams of beta-carotene. Results showed neither had an increased or decreased risk of cancer. In another clinical trial people were given beta-carotene to see if it would prevent skin or lung cancer or precancerous lesions in the colon, and it did not. Beta-carotene and other carotenoids may reduce the transmission of AIDS from mother to infant. Where do you get beta-carotene? Major food sources of beta-carotene are the brightly colored orange vegetables and fruits as well as dark green leafy vegetables. Carrots, sweet potatoes, apricots, pumpkin, cantaloupe,mango, broccoli, spinach and collard greens are excellent sources. What about the other carotenoids? A-carotene: This anti-oxidant may inhibit cell proliferation and halt the spread of cancer. It can be found in carrots, pumpkin and carrot juice. Lutein/zeaxanthin: They are the carotenoids that form the yellow pigment of the macula, a tiny portion in the center of the retina of the eye. These pigments filter out blue light which could damage the eye. People who eat a lot of spinach and leafy green vegetables have less risk for macular degeneration, a common cause of irreversible blindness in people over 65. Studies show that a high intake of leafy green vegetables decrease the risk of cataracts. Good sources for these two carotenoids are collard greens, swiss chard, mustard greens, red pepper, okra and romaine lettuce. Lycopene: Found in watermelon, guava, pink grapefruit, tomatoes, tomato sauces and juice. It has been found to reduce the risk of prostate cancer if consumed frequently. An Italian study also indicated frequent consumption of tomato products decreased the incidence of several forms of cancer. b-Cryptoxanthin: Found in papayas, oranges and tangerines. Is beta-carotene safe? Carotenoids, even in very large amounts taken for years, are not known to be toxic. However, people who smoke or drink more than two drinks a day should avoid b-carotene supplements. Most people can take between 10-20 milligrams of beta-carotene daily without much risk. A milligram of beta-carotene is the same amount as 1,666 IU. Most diets provide about 2 milligrams of beta-carotene. If you take the supplement or eat foods high in carotenes they might turn your skin yellow or orange. Supplements with beta-carotene may keep the body from absorbing other carotenoids that work together to promote lung health. Eating fruits and vegetables (3-5 servings) containing carotenes is a much better nutritonal choice than taking the supplements.

Table A: High fat foods Foods

% of Fat

Bread, Cereals, Grains Breads

2-4

Cereals

trace-2

Pasta(plain)

1-2

Fruit

trace

Avocado

17

Vegetables

trace

Olives

20

Beef (stewed) lean only

15

Beef (stewed) lean; fat

29

Ground beef

19

Roast (rib) lean only

15

Roast (rib) lean; fat

31

Pork sausages

31

Chicken (breast, roasted, without skin)

3

Turkey

5-20

Turkey (light,dark, no skin)

5

Clams, crabmeat, oysters,shrimps

1-2

Salmon(baked)

6

Salmon(canned)

9

Sardines

10

Tuna(oil pack)

8

Tuna(water pack)

2

American

32

Blue

28

Cheddar

32

Cottage(creamed)

4

Cottage(lowfat)

2

Mozzarella

21

Meat

Poultry

Fish

Cheese

Swiss

28

Whole

3.2

Lowfat

2

Non-fat(skim)

than 0

Milk

Other dairy products Butter

81

Vegetable oils

100

Margarines

80

Mayonnaise

79

Nuts

50-70

Soyabeans (dry)

30

Egg yolk

33

Others

Table B: Fatty acids in Oils or Fats

Fat or Oil...

Saturated Fatty acids(%)

Monounsaturated fatty acids(%)

Polyunsaturated fatty acids(%)

Kinds of fats & oils

Canola oil

7

53

22

Monounsaturated

Corn oil

13

24

59

Polyunsaturated

Olive oil

14

74

9

Monounsaturated

Palm oil

52

38

10

Saturated

Peanut oil

17

46

32

Monounsaturated

Safflower oil

9

12

74

Poluunsaturated

Soyabean

15

23

51

Polyunsaturated

Soyabeancottonseed oil

18

29

48

Polyunsaturated

Butter

62

30

5

Saturated

Lard

39

45

11

Saturated*

Table C: Quantity of Cholesterol you consume per plate Plate? Food

Serving

Cholesterol (milligrams)

Beef (stewed) lean & fat

3 ounces

87

Beef (stewed) lean

2.2 ounces

66

Beef (ground) lean

3 ounces

74

Meat

Beef (ground) regular

3 ounces

76

Beef steak (sirloin)

3 ounces

77

Bacon

3 stips

16

Pork chop, lean

2.5 ounces

71

Chicken (roast) breast

3 ounces

73

Chicken (roast) leg

1.6 ounce

3 ounces

Turkey, roast, breast

3 ounces

59

Calims

3 ounces

43

Flounder

3 ounces

59

Oysters(raw)

1 cup

120

Salmon(canned)

3 ounces

34

Salmon(baked)

3 ounces

60

Tuna

3 ounces

48

Tuna (oil canned)

3 ounces

55

American

1 ounce

27

Cheddar

1 ounce

30

Cream

1 ounce

31

Mozzarella (whole milk)

1 ounce

22

Mozzarella (part skim)

1 ounce

15

Swiss

1 ounce

26

Whole

8 ounces

33

2%

8 ounces

18

1%

8 ounces

18

Skim

8 ounces

10

Butter

pat

11

Eggs, large

1

213

tblsp.

12

Poultry

Fish

Cheese

Milk

Other dairy products

Others Lard

Fats and Oils Fats and its compounds are known as lipids. Liquids are called oils and solids are fats. A gram of fat contains 9 calories.

Uses of Fat l

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visible fats: ¡ provides a source of stored energy ¡ gives shapes to body ¡ cushions the skin ¡ acts as an insulation blanket that reduces heat loss invisible fat: This hidden fat, ¡ is part of every cell membrane ¡ is a component of myelin , ¡ is a shock absorber that protects the organs ¡ is a constituent of hormones and other biochemicals

Risk factor Heart attack

Saturated and Unsaturated fatty acids Saturated fat: are solid at room temperature and get harder when chilled. Monounsaturated fat: are liquid at room temperature and thicker when chilled. Polyunsaturated fat: are liquid at room temperature and stay liquid when chilled.

Types of cholesterol l

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LDL(bad cholesterol) ¡ protecrs against atherosclorsis.It is main carrier of cholesterol HDL ¡ it recues LDL pecies and brings them back to the liver VLDL ¡ It is main carrier of triglycerides ¡ It is less harmful than LDL ¡ It carries fat to the other parts of the body.

Proteins What is it? Proteins are the building blocks that grow and repair your body. Proteins are needed not only for muscle but also for hair, skin and internal organs. Some proteins travel around your body in the blood as hormones, enzymes and red blood cells. Protein is unique because it is the only food source of nitrogen, which is essential to all plant and animal life. Proteins are made up of chains of amino acids. For each protein, there are specific amino acids in a specific amount, and they are joined in a unique order. This is what makes a chicken different from cheese or a fingernail different from a strand of hair. There are 22 amino acids. Eight of these are called the essential amino acids because they cannot be made by the body and must be provided by the diet. What does it do? l l l l l l

Antibodies, which are made of protein, help you resist disease and infection. Each day, your body loses protein in the form of hair, skin and nails. You also use up protein in all the activities of running and maintaining your body. If you eat protein daily, it is supplied to your body tissue to replenish any loss and repair any injury. For growing infants, children and teens, protein, along with sufficient calories, is necessary for growth of the entire body. Pregnant and breast-feeding women need adequate protein for the fetus, for supporting maternal tissue, and for the production of breast milk after delivery. If you have a cut, undergo surgery, or have an injury or illness, you need protein to recover and to rebuild your body.

Where do you get it? Protein foods are classified in two ways: complete and incomplete. Complete proteins, which come from animal sources such as chicken, fish, dairy and soybeans, contain all the essential amino acids that help build your muscle and body tissue. Incomplete proteins, found in plant foods, such as grains, seeds, nuts, beans and vegetables, provide a varying but limited array of amino acids. A greater variety and amount of incomplete proteins must be consumed to cover all the amino acids needed for protein building. We can compensate for the amino acid deficiencies in an incomplete protein by combining it with another protein, thus providing all the building blocks for protein creation. This is the concept of complementary proteins, in which proteins with opposite strengths and weaknesses complement each other. For example, many cereals are low in an amino acid called lysine, but high in methionine and cystine. Lima beans, soybeans and kidney beans are high in lysine but low in methionine and cystine. Many cultures, including Mexican and Indian cultures, have limited animal protein sources but eat combinations of incomplete foods. Examples of appropriate combinations include: l l l l

rice and beans cereal and milk beans and corn bread and cheese

Recent research indicates that such combinations need not be eaten at the same meal. If they are consumed over the period of a day, the necessary building of muscle and body tissue will occur. Vegetarians thrive on non-animal protein diets because of our body's ability to do this. Use the following chart to help select foods that are good sources of protein. Food

Grams of Protein

6 oz. canned tuna

40

4 oz. chicken breast

35

3 oz. beef*

26

3 oz. turkey

25

3 oz. salmon

23

8 oz. (1 cup) garbanzo beans

15

8 oz. (1 cup) milk

8

8 oz. (1 cup) yogurt

10

4 oz. (1/2 cup) tofu

10

4 oz. (1/2 cup) cottage cheese

14

1 egg

6

1 oz. cheddar cheese

87

8 oz.(1 cup) pasta

5

*A 3 ounce serving of beef (or chicken) is about the size of a deck of cards. How much do we need? Your protein needs are determined by your age, sex, weight and whether you are pregnant, lactating or in intense sports training. The accompanying chart indicates the recommended daily amounts for different types of people. You may calculate the amount of protein you need daily by multiplying your weight in pounds by the number that corresponds to your situation, as shown here. This will give you the recommended grams of protein per pound of body weight per day that is appropriate for people of your sex, age and/or activity level. Sedentary adult

weight x 0.4 = number of grams of protein needed

Adult recreational exerciser

weight x 0.5-0.75 = number of grams of protein needed

Adult competitive athlete

weight x 0.6-0.9 = number of grams of protein needed

Adult who is building muscle mass

weight x 0.7-0.9 = number of grams of protein needed

Dieting athlete

weight x 0.7-1.0 = number of grams of protein needed

Growing teen-age athlete

weight x 0.9-1.0 = number of grams of protein needed

Using this formula, you can calculate that a 140-pound sedentary female, for example, would need 56 grams of protein (140 x 0.4) per day. A 170pound male would need 127.5 grams (170 x 0.5-0.75). The amount of protein needed by athletes is the subject of active research. Currently, the American Dietetic Association recommends that athletes consume 1.5 grams of protein per kilogram of body weight, or about twice the Recommended Daily Allowance (RDA). How to increase your protein intake Here are five ways to increase protein in your diet if you need more than you are currently getting. 1. Increase your meat serving at lunch or dinner by just one ounce to add seven more grams to your daily protein intake. 2. Make a high-protein breakfast drink by blending a cup of yogurt or silken tofu, a cup of milk and your favorite fruit. Bananas and strawberries work well. You may want to add ice. 3. Add shredded cheese, cottage cheese or garbanzo beans to a tossed salad at dinner. 4. Add a little protein to your snacks. Put peanut butter on apples, drink milk with cookies, or use cheese cubes to make a kabob with grapes, pineapple and cherries. 5. Mix protein into foods. For example, you can make an eggnog of egg substitutes, milk and sweetener, stir nonfat dried powdered milk powder into hot cereal or mashed potatoes, or add powdered egg whites to applesauce.

Desirable

Below 130

Desirable for people with heart disease

Below 100

If you need to lower your LDL, try taking these steps. l l l

Take the steps described earlier to lower total cholesterol and increase HDL cholesterol. Stay as close as possible to your ideal weight. Keep your fat intake down.

There is also evidence to indicate that anti-oxidants may prevent clogging of the arteries by blocking LDL from being oxidized. Vitamin E and vitamin C are showing great promise in this area, and dietary beta-carotene also has shown some effect. Triglycerides Triglycerdides are a type of fat found in the bloodsteam. Triglycerides only recently have begun to be considered important in cardiovascular health. High levels of triglycerides are now generally associated with a high risk of CHD. Triglyceride Levels Very High

1000

High

400-1000

Borderline

200-399

Normal

Below 200

High triglycerides are often attributable to excess weight or to heredity. In some cases, however, they may be associated with the carbohydrates in a very low-fat diet. They are not associated with all carbohydrates, however. Simple sugars and refined flours (such as those in a diet that is high in sugar and in low-fat products such as cookies, pretzels and pasta) tend to raise triglyceride levels in some people. On the other hand, whole grains and fruit do not seem to pose a large problem. Here is what you can do to lower your triglyceride level. l l l l

Reduce total fat and saturated fat intake. Eat less sugar. Avoid alcohol. Eat more fish high in Omega-3 fatty acids.

Lp (a) Lp(a) is a form of LDL cholesteral, or "bad" cholesterol. It is emerging as another risk factor for CHD, and elevated levels of Lp (a) in your blood should be of concern. However, it is not clear how to lower a high Lp (a) level. Some preliminary findings point to aspirin, red wine and Omega-3 fatty acids from fish as possibly lowering Lp (a) levels. More research is needed before specific dietary recommendations can be made, but following a hearthealthy diet is a good start. Fifteen Ways to Lower Your Cholesterol Through Diet 1.Cut your total fat intake. The risk of heart disease falls sharply if you reduce fat to less than 30 percent of total calories (as opposed to the 34-54 percent that is typical in the United States). When you lower fat consumption, you also reduce your saturated fat intake, cut calories and lose weight. Exactly how much of your diet should come from fat is a matter of controversy. Too little fat may be as bad as too much, although this idea is somewhat controversial. It probably depends on your specific health profile. Two very different programs have proven track records: l

Dr. Dean Ornish, a cardiologist, has published a number of books about his program, which has been proven to reverse heart disease. His plan includes exercise, meditation, support groups, an almost-vegetarian diet, and fat intake of only 10 percent. Ideal weight is also a goal of this plan. Overweight people with high cholesterol and Type A personalities will greatly benefit from Dr. Ornish's program. It is rigorous, rigid and effective.

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Advocates of the Mediterranean Diet, on the other hand, promote a diet of 30 percent fat. The recommended sources of fat, though, are largely olive oil, fish and nuts. People on this diet eat a good deal of cheese and yogurt, but they rarely eat red meat and pork and drink wine only in moderation. People of the Mediterranean have a lower incidence of heart disease and stroke than Americans.

If you are on a low-fat, high-carbohydrate diet, yet you also have low HDL (good) cholesterol and high triglycerides, you may need to reconsider the quality of your low-fat diet plan. Your carbohydrates should be coming from whole-grain cereals and breads, fresh fruits and vegetables. Your diet should include only a minimal amount of sugar. If you are taking advantage of fat-free "fun foods," such as low-fat sweets, pretzels and pasta, along with fat-free ice cream and desserts, you may be unintentionally raising your triglyceride level. 2. Eat less cholesterol- rich food. Your daily cholesterol intake should be 300 milligrams or less. Certain animal foods are rich in cholesterol, but no plant foods contain cholesterol. Keep these food facts in mind. l

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A single egg yolk has 255 milligrams of cholesterol; if you are healthy, you should eat no more than two egg yolks per week. (If you already have heart disease, you may be advised otherwise.) Egg white has no fat or cholesterol, so you might consider eating egg whites and egg substitutes frequently. Egg white is also an excellent form of protein. Organ meats and certain seafoods -- shrimp, lobster and calamari -- have high levels of cholesterol.

The body makes cholesterol. In most cases, the more cholesterol a person eats, the less the body makes. However, 20-30 percent of Americans are not able to balance the cholesterol they produce and the cholesterol they ingest this well; as a result, they may have excessively high cholesterol levels. 3. Avoid saturated fats.

In terms of heart health, there is nothing good to be said for saturated fats! They are to blame for increasing total cholesterol, LDL cholesterol and triglycerides. l l l l

Less than one-third of your fat intake should come from saturated fat. You find saturated fat in dairy fats such as cream, butter and cheese. Saturated fat is also in animal fats like chicken skin, visible fat on meat, and lard. The chemical structure of saturated fats makes them solid at room temperature.

4. Avoid tropical oils. The tropical oils are palm, palm kernel and coconut oil. They are highly saturated. Many prepared foods contain them, so check labels for ingredients. You are likely to find tropical oils in these products. l l l l l

non-dairy coffee creamers whipped toppings baked goods cookies chocolate candy

5. Reduce your intake of transfatty acids. Transfatty acids are compounds that occur when foods are chemically modified by partial hydrogenation. The safety of transfatty acids has been a controversial subject. Recent studies have helped resolve the issue; for instance, a US Department of Agriculture study showed that transfatty acids from partially hydrogenated vegetable oil raise cholesterol as much as saturated fats do. Fatty acids may also reduce HDL cholesterol (good cholesterol) and raise Lp (a). 6. Increase your use of monounsaturated fats within your total allotment for fat. Monounsaturated fats lower blood cholesterol and will reduce your risk of heart disease. l l l

Monounsaturated fats are liquid at room temperature. They are the main fatty acids in olive oil and canola oil. Use olive and canola oil in your cooking and in salad dressings to promote heart health.

7. Use polyunsaturated fats. Polyunsaturated fats are the major fat source in vegetable oils such as safflower oil and corn oil. They generally lower total cholesterol, although they may also lower HDL cholesterol (good cholesterol). l l

Try to use less hydrogenated margarine; liquid and tub margarine are better than stick margarine. Some less hydrogenated products may contain trans fatty acids, but you can avoid them by reading labels. The newest types of margarine are labeled "without transfats."

The primary polyunsaturated fatty acid is Omega-6, or linoleic acid, a fatty acid that is essential to our growth and development. Widespread use of Omega-6, however, may have upset the balance with Omega-3. This imbalance may be a cancer risk. 8. Get your Omega-3 fatty acids. Omega-3 fatty acids are polyunsaturated fats from plant and marine sources. Omega-3 is an essential fatty acid, linolenic acid. The richest sources are fish that swim in cold waters, such as those listed here; try to eat them 3-4 times a week. l l l l l l

salmon bluefish mackerel tuna herring sardines

The benefits of eating these food sources of Omega-3 include the following. l l l l l

significant reductions in high triglyceride levels slower blood clotting prevention of abnormal heart rhythms enhanced immune function improved eye and brain development

If you do not eat fish, be sure to include other foods rich in linolenic acid, such as these. l l l

walnuts walnut oil flaxseed oil

A note of caution: Do not use fish oil capsules without medical supervision; their concentrated levels may interfere with other medications. 9. What about shellfish? l l l l l l

Shrimp, although moderately high in cholesterol, is a very low-fat protein. Eaten once or twice a month it will not affect cholesterol levels. All other shellfish are also acceptable, except squid (calamari) and roe (caviar). Mollusks such as clams, mussels and scallops are all fine. Be sure shellfish are from reputable sources and are cooked well. Have your seafood baked, broiled, steamed or boiled -- but not fried. Use only acceptable oils in preparing shellfish recipes which call for oil.

10. Increase the soluble fiber in your diet.

Remember the oat bran craze? Well, there is nothing crazy about eating a lot of soluble fiber-which is found in oat bran, in abundance-if you want to lower your cholesterol. The soluble fiber in oats, called beta-gluca, has specifically been proven to reduce blood cholesterol. A high daily intake of soluble fiber, through generous servings of oat- and bean-based foods, helps to eliminate cholesterol-laden bile acids and fats from your body. Soluble fiber is found primarily in these foods. l l l l l l l l

oats legumes apples pears plums carrots okra barley

Some people take soluble fiber in the form of psyllium seed; this is most effective when taken with your largest meal of the day. It has little effect on cholesterol reduction when taken at bedtime. 11. Be sure to get enough folic acid, vitamin B6 and vitamin B12. Low levels of folic acid and other B vitamins can cause excessive homocysteine to be produced in the body, and high homocysteine levels are an independent risk factor for heart attack and stroke. You need 400 micrograms of folic acid a day to prevent heart disease. A multivitamin will provide the recommended amount. Foods that will also do the job include the following. l l l l l l l

Total cereal Product 19 lentils asparagus spinach kidney beans orange juice

12. Try more soy protein. A number of studies have shown that soy protein lowers cholesterol. Soy has isoflavones, called daidzein and genistein, which are the plant estrogens that play a role in cholesterol metabolism. Soy protein is a good protein that can be substituted for animal protein in your diet. Here are some sources of soy protein. l l l l

tofu tempeh veggie burgers made with textured vegetable soy protein soy milk

Experts recommend 25-50 grams of soy protein daily, or 60 milligrams of isoflavones, to reduce cholesterol. 13. Get more anti-oxidants. Anti-oxidants retard the development of "free radical" cells that are implicated in heart disease and cancer. Oxidized LDL (bad cholesterol) is damaging to the arterial wall. Certain vitamins and other compounds provide anti-oxidant effects. l l l

Vitamin E is an anti-oxidant; doctors recommend 400-800 IU daily for heart patients. Vitamin C is recommended as an anti-oxidant at 350-500 mg a day. Beta-carotene is recommended at 15 micrograms a day.

14. Go beyond vitamins -- and get your phytochemicals. Phytochemicals are plant chemicals that may help prevent not only CHD, but also other chronic diseases and conditions such as diabetes, cancer and hypertension. l l

Fruits and vegetables are chock-full of them; eating five servings a day is a good start on the road to better health. Garlic may help reduce blood cholesterol, LDLs and triglycerides; garlic pills are being studied now, but the results so far are inconclusive. It appears that raw garlic is the active ingredient.

15. Shape up! l l l l

Get a lot of exercise. It will help you lose weight, increase your HDL (good) cholesterol and lower your triglycerides. Lose weight if you need to. Losing just 10 pounds can make a difference in your cholesterol level, especially if your body is an "apple shape." Your waist measurement divided by your hip measurement should be less than 0.9 for men and less than 0.8 for women. If you smoke, stop.

Facts About Fats Oils and fats are usually a mixture of the three kinds of fatty acids -- monounsaturated, polyunsaturated, and saturated. For heart -- healthy eating, keep these guidelines in mind. l l l

Choose food products with more monounsaturated and polyunsaturated fatty acids Reduce your use of saturated fats Refer to this chart to make healthier choices. Dietary Fats

Percentage of Saturated Fat %

Percentage of Monounsaturated Fat

Percentage of Polyunsaturated Fat

Canola oil

6

62

31

Safflower oil

10

13

77

Sunflower Oil

11

20

69

Corn Oil

13

25

62

Olive oil

14

77

9

Sesame oil

14

40

42

Soybean oil

15

24

61

Peanut oil

10

49

33

Margarine, soft

19

49

30

Chicken fat

31

47

21

Lard

41

47

12

Palm oil

50

40

10

Beef fat

52

44

3

Butter

66

30

2

Margarine, stick form

80

14

16

Palm kernel oil

86

12

2

Coconut oil

92

6

2

How to Reduce the Saturated Fat in Your Diet Try these suggestions for replacing saturated fat in your diet with improved fat choices. Food High in Saturated Fat

Lower Saturated Fat Alternative

Cream Cheese

Light cream cheese in a tub

Butter

Whipped margarine

Spray margarine

Butter Buds or Molly McButter

Egg

2 egg whites or egg substitutes

Chocolate

Cocoa with margarine

Ground Beef

Lean ground turkey, soy protein crumbles

Mayonaise

Light mayonaise

Shortening (1 cup)

Margarine (1 cup) or canola oil (3/4 cup)

Sour cream

Non-fat yogurt or non-fat sour cream

Cooking oil

non-stick pan, Pam cooking spray

Powdered coffee creamer

Non-fat dried skim milk